Healthcare Provider Details

I. General information

NPI: 1568480440
Provider Name (Legal Business Name): DAVID PITTS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SAKELARES BLVD
GRANTS NM
87020-3819
US

IV. Provider business mailing address

1040 SAKELARES BLVD
GRANTS NM
87020-3819
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-4489
  • Fax: 505-287-8441
Mailing address:
  • Phone: 505-287-4489
  • Fax: 505-287-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number94-120 D.P/94-121 JP
License Number StateNM

VIII. Authorized Official

Name: DR. DAVID B PITTS
Title or Position: OWNER
Credential: MD
Phone: 505-287-4489